Share Mayflowers - Pregnancy

Expert Commentary

We are fortunate to work closely with many wonderful perinatal health provides and are thrilled to feature Q&As with them here. This week we hear from two midwives:

  • Jill Fieleke, CNM at Mount Auburn Hospital, active in clinical practice and former facilitator of Mount Auburn’s weekly postpartum support group.
  • Chris Just, CNM, clinical thought leader with over 20 years of experience as a certified nurse-midwife in both educational and clinical roles. The interview with Chris is from 2012 when she was the Executive Director of Pre-natal Education at Isis Parenting.

Jill Fieleke, CNM

Please share with us what you are seeing most in practice as it would relate to this theme of perinatal health:

During the 2nd and 3rd trimester, I commonly see women experiencing low back pain, hip pain, sciatica, pubic symphysis separation and general joint instability. Postpartum issues include recovery from cesarean section, recovery from laceration (perineal tears during vaginal delivery), pubic symphysis separation, and postpartum urinary incontinence.

Please describe your patient population and what types of questions they are asking you on a regular basis:

Preconception/prenatal/postpartum/routine and problem-based gynecology. There’s a huge diversity of questions and needs. Women are concerned about having a healthy pregnancy, a normal birth (optimally without tearing!), and an expedient postpartum recovery. They are interested in regaining their sexual health postpartum. Many women have pain with intercourse and/or urinary issues that they don’t discuss with their providers, so I get a lot of questions from women when these are problems for them!

What different interventions, non-surgical and surgical, do you recommend for those having these problems?

It varies by question, but I talk about overall health/nutrition/exercise/rest. I talk about exercises to strengthen the core and the pelvic floor. I refer to physical therapy and to urogynecology and sometimes to mental health providers.

Are there any conversations that you are having repeatedly with your patients that involve discussing information you wish was communicated to them and other women by other health care practitioners and the media?

I wish that women didn’t have the idea that at 6 weeks postpartum they should be “back to normal” in every possible way. I try to prepare them for the fact that it will likely take more than 6 weeks - and perhaps up to a year - for them to regain their physical/emotional/sexual equilibrium. I also wish there were less shame in talking about sexual issues, and urinary and bowel incontinence.

What changes would you like to see in Women’s Health in the next five years? Would you like to see more research to be performed in any particular areas?

What a fantastic question! And one for which I”ll likely keep thinking of additions to these comments! I would wish for a more holistic approach to women’s health, and one that accounts for the many roles that women play in their families and in the community. I think that group versions of care are an excellent modality for women - whether it is physical or mental health care. I’d like to see more programing for adolescent girls.

Chris Just, CNM

Please share with us your main experiences in practice (clinical, Isis) with regard to perinatal health.

I am a certified nurse-midwife and worked in clinical practice for 10 years. I practiced full-scope midwifery, which included seeing women for their prenatal appointments, attending over 500 hospital and birth center births, offering primary care and annual GYN appointments and participating in early newborn care and breastfeeding support. While having my own children, I left clinical practice to work at Isis Parenting where I am the Executive Director of Prenatal Education. My goal at Isis is to educate and support expecting women and their support persons so they feel empowered to engage in shared decision-making with their providers. Our focus is on offering evidence-based information and presenting healthy choices for birth for women of all socioeconomic levels.

What types of questions are women asking/what info are they seeking on a regular basis when they come in to Isis?

At Isis we provide education, support and products from conception to age three so our clients present a very broad range of questions that reflects their wide variety of philosophies and experiences. We welcome them all! Our clients want current information on best practice for birthing and parenting, safe products for themselves and their baby and easily accessible support when they are experiencing perinatal mood changes, newborn sleep issues or breastfeeding complications. They want to know the differences between the many swaddling blankets, slings and baby carriers, strollers and car seats. They want to know how to get their bodies strong again after having a baby. Each Isis instructor, client consultant and center associate is well-equipped to be a trusted guide and help find the answers every step of the way.

How do you answer these questions and provide resources?

Prenatal resources at Isis include our several varieties of childbirth education classes including a standard Prepared Childbirth class for those who are certain they want an epidural to our Two-Day Natural or 5–Week Mind Body Birth class for clients that prefer an un-medicated birth experience. We also provide an online class for women on bed rest and a Combo class that involves self-learning followed by a 3 hour on-site session. Each class is comprehensive and covers all questions related to labor and birth. In addition we offer breastfeeding, early parenting and CPR/safety classes. After the birth we run new moms and new dads groups, child development series and music and movement classes. For general wellness, we offer prenatal and postpartum fitness, yoga and massage. We provide lactation consults, sleep consults and emotional wellness support. To increase access for those in need, we offer class scholarships and free community classes at health centers in Revere, Chelsea and Salem (MA).

Is there anything you would like to add beyond what you are commonly seeing in your environment – what questions aren’t being asked enough?

There are a couple of issues that women seem especially afraid to discuss. One is the issue of pelvic floor dysfunction. The conversation among women on this topic does not match its prevalence. It is reminiscent of the way women were self-conscious about menopause in decades past; instead of having open discussions they would whisper about “the changes” they were going through and were too embarrassed to seek out support. The other issue that we all need to talk more about involves perinatal mood disorders. The MA Legislative Commission on PPD is working hard to promote the use of screening and referral in both the prenatal and pediatric provider communities to improve outcomes. I am proud to represent Isis in the commission’s Pubic Education sub-committee.

What conversations that you are having repeatedly with your clients around information you wish was communicated to them and other women by other health care practitioners and the media?

In addition to more communication about prevention and treatment for pelvic floor dysfunction and screening and referral for perinatal mood disorders, I would add that, in general, patients appreciate when providers present choices and engage in shared decision-making. I have been hearing complaints from women about the lack of introduction and communication on the part of some residents before they perform cervical exams. I also hear that women are unprepared for how tired, weak and sore they feel after birth and how difficult breastfeeding can sometimes be so I think there can be more education by providers and nurses on this topic in addition to clients hearing about it in our classes. I believe that our culture needs to value the early parenting period more than we do currently. Women are expected to get right back into the groove after having a baby because of media portrayals and also the pressure we put on ourselves. The parent – child bond is priceless and we need to treat it as such.

What changes would you like to see in Women’s Health/Perinatal Health in the next five years? Would you like to see more research to be performed in any particular areas?

I would love to see more campaigns similar to the March of Dimes’ Healthy Babies Are Worth the Wait and more initiatives such as Childbirth Connection’s Transforming Maternity Care. We are seeing improved outcomes now that elective deliveries prior to 39 weeks are no longer encouraged; however, I would also like to see the C-section rate decline to a level that is closer to the WHO recommendation of 15%. Personally, I would also love to see nitrous oxide used in more U.S. hospitals as another option for labor pain relief. Finally, I think we need to bridge the gaps in perinatal care. Isis recently brought together a cross-section of perinatal specialties to discuss how to go about achieving that goal. An outcome of our gathering was our new blog for clinicians, educators and other professionals, Connections In Care, which includes newsfeed of latest perinatal research. We hope that by building connections and working together we will achieve some of these goals sooner than 5 years.